Maria Eagle: Britain’s business community finds it incredible that the Government have no intention to bring forward a proper strategy for aviation and UK airports for the next two years. Opposition Members believe that any expansion in aviation must be sustainable, but is it not a nonsense for the Government to rule out any expansion in the south-east, regardless of whether or not it can be demonstrated to be sustainable. Is not the chief executive of London First right when she warns that this failure is
	“damaging our economy and enhancing that of our EU rivals”?

Norman Baker: I understand the hon. Gentleman’s concern, of course, but the fact of the matter is that the Humber Bridge Board applied for an increase. I decided unilaterally to have a public inquiry, where people’s representations could be heard. The inspector came back with a clear recommendation in support of the board application for an increase, and there is no reason for Ministers to take a contrary view. What I would say, however, is that there has been no increase in the toll since 2006.

Diana Johnson: In the general election, the Liberal Democrats ran a “Ditch the Humber Bridge Debt” campaign. In light of the Minister’s decision to endorse the 11% increase, should he not think again? Is this not another example of the Lib Dems’ promises in the manifesto being broken now they are in government?

Nigel Mills: When it comes to providing toilets, and indeed the whole rolling stock, can the Minister assure me that there will be a level playing field so that there is a fair chance that rolling stock can be constructed in Derby in the UK, rather than in Germany as in the announcement last week?

Kevin Brennan: Do I take it from that reply that the Secretary of State is considering a complete sell-off of the Government’s interest in NATS? Can he also tell us what consultations he is having with the staff and the airline group about their views on the matter?

Duncan Hames: I certainly endorse the Minister’s most recent remarks. Residents in Melksham in my constituency will want to do a lot better from the new franchise than they did from the last one. Can he tell us when the public will have an opportunity to contribute to a consultation on the draft specification for the new Great Western franchise?

Tobias Ellwood: Not all the events are taking place in London. Bournemouth is still coming to terms with losing the bid for the beach volleyball to Horse Guards Parade. However, Weymouth is delighted to be hosting the sailing events. Can the Secretary of State outline what improvements to transport will take place for 2012 in that area?

Theresa Villiers: Of course, I am well aware of the Mayor’s ambitions to get a no-strike agreement, which I think would be very positive if he can negotiate it with the unions. With regard to changing strike law, the Government are not rushing to any kind of confrontation with the unions, but Mr Crow and his colleagues at the RMT must recognise that the more irresponsibly they behave, holding London to ransom, the more they strengthen the argument of those who want a change in strike law.

Disability Hate Crimes

Hilary Benn: I am grateful to the Leader of the House for that reply.
	On tonight’s vote on stopping the use of wild animals in circuses, will the Leader of the House reassure us that the Government are not whipping their vote? Would it not be ironic if the whip were used to defeat the ban so that people can go on cracking a whip at circus animals?
	It is learning disability week, and yesterday I met a group from Leeds who had come to tell MPs that they face discrimination every day. Does the right hon. Gentleman agree that any idea that disabled people should be paid less than the minimum wage would be outrageous discrimination, and may we have a statement condemning it?
	Following your comments on Tuesday, Mr Speaker, about the Government holding press conferences on major policy announcements before they come to the House to answer questions from MPs, will the Leader of the House now make time available for the Procedure Committee’s proposals on ministerial statements to be debated? The Committee’s idea that Ministers would be forced to make a formal apology on the Floor of the House for breaching the rules might concentrate the Government’s mind.
	Last week I asked the Leader of the House about reconsidering the strategic defence review. Yesterday the Prime Minister came to the House and let slip that he is doing so already, although he had not previously told anyone, least of all the House of Commons. In the Prime Minister’s own words:
	“We have had a review of the national security and defence review over the past year”—[Official Report, 22 June 2011; Vol. 530, c. 315.]
	When can we expect a statement on the outcome of the review?
	This week the climate change Secretary attacked right-wing ideologues and deregulation zealots for putting environmental regulations, including those in climate change and national parks legislation, on a list of so-called red tape that might be scrapped. We wish the Secretary of State well in his fight to save the regulations, but has the Leader of the House had any indication that the Cabinet Secretary’s right-wing, zealous Cabinet colleagues—presumably they were who he was talking about—have asked to make a statement by way of right of reply to this grave charge? If not, may we at least be given a list of their names so that we can keep score?
	On the subject of zealots, may we have a statement from the Prime Minister on how he has got on since PMQs yesterday in his desperate attempts to prevent Tory MEPs from voting against a 30% reduction in emissions—which is, after all, a coalition policy—in the European Parliament today? This is a real test of his authority, and if he fails it his claim to be leading the greenest Government ever will be in tatters.
	May I offer the Leader of the House an apology? I fear that my comments on weekly bin collections may have inadvertently contributed to a widening of the rift between the environment Secretary and the communities Secretary over whose turn it is to take the rubbish out. The Daily Telegraph today reported:
	“Cabinet pair ‘at daggers drawn’ after bitter bin collection feud.”
	It seems that the right hon. Lady hung up on the right hon. Gentleman, and the pair are thought not to have spoken since. A colleague said:
	“The whole thing is fairly unpleasant. . .”
	So may we have a statement on why this fragile coalition inside the Conservative party now seems to be falling apart?
	After all the policy changes, pauses, rethinks, repudiations, and U-turns in the past few weeks—by the way, I congratulate the Foreign and Commonwealth Office website on its honesty for yesterday announcing changes to the BBC World Service with the headline
	“Massive U-turn on BBC World Service funding”—
	did the Leader of the House see the conclusion drawn by one unhappy Conservative MP who this week said:
	“It’s not worth going out on a limb for something if it may be abandoned when the tabloids or the Lib Dems kick up”?
	Pity the loyal Back Benchers: they are keen to help, eager to please and want to back their Government, but they now have absolutely no idea, with all this prime ministerial hokey cokey, whether policies that are in this week might be policies that are out next week, or at the very least shaken all about. May we therefore have a statement reassuring them that if they do take the plunge and voice support for the Government, they will not be left high and dry as so many of the Prime Minister’s Cabinet colleagues have found themselves in recent weeks? Finally, does this collective loss of nerve by the Government not show just how right was the Treasury mandarin who last week complained:
	“They just don’t seem to have thought any of this stuff through”?
	Sir Humphrey could not have put it better himself.

Chris Heaton-Harris: The Local Government Boundary Commission’s review of Daventry district has united all political parties locally and a huge number of the parishes against the proposals. Few if any of the views expressed in the consultation period have been taken into account, and I am being asked to pray against the measure when it is placed before the House after the summer. Can the Leader of the House advise me on the parliamentary routes available to me to get the Local Government Boundary Commission to listen to the views of my constituents?

Stephen Twigg: Will the Leader of the House find time for a debate on the situation in Sudan? In recent weeks, tens of thousands of Nuba people have been displaced from their homes, and we have seen the resumption of aerial bombardment by Khartoum. In two weeks’ time, South Sudan takes its place in the League of Nations, but the situation is very fragile. May we have an opportunity to debate it in the House?

Bridget Phillipson: My constituent Joe Arthur was attacked, and subsequently died, while on holiday in Corfu in 2006. Five years on, the three individuals connected to his death are still awaiting trial in Greece. Mr Arthur’s family have received exceptional support from Northumbria police, but they want justice. Can the Leader of the House arrange for me to meet a Foreign Office Minister to discuss the case and see what further assistance can be offered to the family?

Backbench Business
	 — 
	[29th allotted day]

Transport Committee (Coastguard)

Albert Owen: I congratulate the Committee and my hon. Friend as its Chair on an excellent report. I think the Government will take notice of it, because they said they would wait for the report and act on its conclusions. Does my hon. Friend agree that had coastguards across the United Kingdom had an opportunity for input as to the future of the service, MPs’ debates would have had a different tone? More important, are not the proposals a way forward for the Government, not a way out, and must they not include input from all coastguards?

Stuart Andrew: That is a very good description of the meeting. I agree with my hon. Friend. If nothing else, it is good that this debate got the review board to come to Parliament and speak to MPs so that we could express our concerns.
	On the case for Leeds specifically, as I said a moment ago, co-location of services is considered crucial by the BCCA. In Leeds we have one of the largest children’s hospitals in the country. A considerable amount of time has been spent bringing all the children’s services under one roof at Leeds general infirmary. The centre serves a population of 5.5 million. I cannot understand why the option has not been considered for Leeds when it has been considered for centres in Birmingham and Liverpool. Yorkshire has a growing population and a growing BME community. As I said, 20% of the patients come from that community. It is crucial that we take account of population numbers when considering the review.
	How we care for all those families is also important. When I worked at Martin House children’s hospice, it was not just the care of the poorly child, but the care of the whole family, that was important. When people have a very poorly child, they want their family to be together. It has been said that parents will travel anywhere. Of course they will, but does that mean that we should make them travel, when there could be alternatives?
	The Yorkshire and Humber congenital cardiac network board has a well- established network model, is regarded as an exemplar in this country and is held in high regard across the region by both the professionals and the patients involved in the service. Although this was recognised by Sir Ian Kennedy’s expert panel and Leeds Teaching Hospital Trust was awarded the maximum score for networks in that assessment, the JCPCT, as part of the scoring of options for future configuration of centres, gave all potential networks the same score. It is unclear why a proven track record of delivering an exemplary network model was not considered an important factor in the ability to deliver this across a larger population and greater geographical spread in the future.
	On the requirement for a minimum of 400 operations, Leeds delivered 316 cardiac operations in the 0 to 16-year-old group in 2009-10 and 372 in 2010-11. The process of recruiting a fourth surgeon is under way. By the time the review’s recommendations are implemented, Leeds Teaching Hospital Trust will deliver the minimum number of operations, which is 400, and the minimum number of surgeons, which is four, that the standards require from within the current population base. Equally, Leeds Teaching Hospital Trust has provided detailed information to the Safe and Sustainable team for expansion of the current service, should it be required to deliver a change in capacity to support patients from a centre that does not get designation.
	The review said yesterday that the debate is not about current services. It is about what will be provided in the future. The figures that I have cited show that Leeds’ case for being a centre caring for more than 400 patients is strong. Many patients and particularly clinicians have pointed out to me that it seems odd that we are having a review of children’s heart services without referring to adult services. Many of those patients will be the same: those children will grow up, and the doctors who perform the operations are often the same people caring for both groups, so why are we not looking at adult services now? It has been suggested that that review should come later, but if we have made decisions about children’s heart surgery, surely we have pre-empted what might happen in the future.

Stuart Andrew: I could not agree more. My hon. Friend is right; if we have a review of children’s cardiac services, surely we must consider what will happen to adult services. We should be talking about that now.
	I could go on much longer and talk about the cases of various parents whom I have met, but I know that other hon. Members will do that, probably far more eloquently
	than I could. I am keen that the motion is supported because I want it to send a clear message to the review team that we are asking it to consider all the points that are made today and all the points that have been made by the campaigns across the country. It was a privilege to go to Downing street the other day with children, patients and clinicians from the Leeds centre to present a petition of more than 500,000 names. That is a significant petition by anybody’s standards and a credit to that campaign.
	I am concerned that after consideration of the consultation responses, it will be difficult to respond to all the evidence by pigeon-holing them into the four options in the review. That is why our motion today urges the joint committee not to restrict itself to those four options and instead to think outside the box, as they say. Let us look at a different proposal that delivers the services and the quality that we want and also takes account of all the responses that we have received.
	Finally, I want to pay a personal tribute to all the families and campaigners, especially in Yorkshire and the Humber. In all the campaigning that I have ever done, I have never seen such a well organised and dedicated campaign. The subject is sometimes emotional, but the responses that have come from patients across Yorkshire shows that there can be an alternative that delivers the services that we want. I hope the House will support the motion.

Nigel Evans: As hon. Members can see, this is a popular debate. There is, therefore, a six-minute limit on contributions.

Stephen Dorrell: Like the right hon. Member for Oxford East (Mr Smith), I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on introducing the motion, which is of huge importance to my constituents and to the national health service. In contributing to the debate, I have two hats. First, I represent the village of Glenfield. Glenfield hospital is actually in the neighbouring constituency of the Opposition spokesman, the hon. Member for Leicester West (Liz Kendall), but it takes its name from the village in my constituency. Secondly, I am Chair of the Health Committee. The Committee has not approached the subject specifically, because we have been looking at a number of other matters, but we have so far published two reports on commissioning, which is precisely at the heart of today’s debate.
	In a sense, I personalise the conflict that every Member feels between the constituency interest and the national interest, and in this case I do so in a particularly dramatic form, as one of the surgical units involved is closely associated with my constituency. My first point is that that conflict exists for all Members. We are of course here to represent our constituents’ interests, but I argue that we are here first and foremost as Members of a national Parliament and should seek, as my hon. Friend the Member for Pudsey recognises, the right answer for all NHS patients, not simply for a particular local interest.

Stephen Dorrell: I agree with the hon. Gentleman’s point.
	My hon. Friend the Member for Pudsey said that this is not a political issue, by which he meant that it is not a party political issue. That is exactly right, but issues can be political without being party political. It is important that the House, in approaching the subject, makes it clear that the issue should ultimately be resolved according to clinical standards, not as a form of political bartering, whether party political or through the general representation of local interests.
	I am in the happy situation, personalising, as I do, the conflict between local and national interests, that the specialist group has recommended a solution that accords with my constituents’ views, but I think that in approaching the subject it is important to be clear about the ladder of interest: we should approach this from the point of view of national standards for the service delivery. We of course should represent the views of our constituents, but we should be clear that the national view should come first.
	Writing in The Timestoday, Sir Bruce Keogh, the medical director of the NHS, states:
	“Intellectually, the case for change is compelling and widely accepted. Sadly, the realpolitik is that the closer we get to a
	solution, the more personal, professional and political interests conspire to perpetuate mediocrity and inhibit the pursuit of excellence… For too long this has been filed in the ‘too difficult’ box. Time is running out.”
	Those words should ring loud in our ears as we debate the subject this afternoon.
	We should recognise that the whole issue of child heart surgery has form in the history of the national health service. It is now over a decade since Sir Ian Kennedy published his review of circumstances that illustrate what can go tragically wrong when things are allowed to drift on and when real issues are not addressed. Although I am of course here as a Member representing my constituents’ interests, I think that the key priority for the House this afternoon is to support the principle that this issue must be decided in the interests of the children who are the patients and who will become the adult patients, and in a way that satisfies the key driver of the pursuit of excellence in clinical standards.
	I welcome the fact that the previous Government set up the review to ensure that we addressed the issues that had been left to drift on for too long since the Bristol heart review a decade ago, and I wholeheartedly endorse the view, expressed by Sir Bruce in today’s Times, that the time to act is now.
	As a local MP, I wonder what the effect is on Leicester of this drive to a decision. I have already referred to the fact that I am not in an uncomfortable position, because on page 93 the review states:
	“Option 2”—
	which became option A—
	“is viable as it is consistently the highest scoring potential option.”
	The review’s recommendation is that the process go ahead based on option A, and that is convenient from the point of view of the person arguing the case that I do, but I conclude that if anyone wants to argue for an alternative outcome, it behoves them, particularly in view of the history of this issue in the national health service, to present a coherent, whole argument for how their solution represents a better solution for the patients of those services, while reflecting, of course, the local interest of the people we are elected to represent.

Nick Brown: If my hon. Friend will forgive me, I will not.
	There is strong clinical support for the review. The relevant royal colleges have all endorsed it; the available research evidence underpins it; and all 10 specialised commissioning groups and their local primary care trusts committed themselves to it at the outset. That seems to be a pretty formidable case.
	I am the constituency Member for the Freeman hospital in Newcastle upon Tyne, and on 10 June I visited its paediatric surgery unit. I never cease to be impressed by the care, kindness and surgical skill that the national health service provides. It is very moving to see very young children whose lives are literally being saved, and to meet youngsters who, 20 years ago, would not have had a chance of life. The unit at the Freeman is one of two children’s heart transplant units in England, the other being Great Ormond Street in London, and of course the unit benefits enormously from its link with the internationally renowned adult cardiac services on the same site.
	The expertise at the Freeman has been built up over decades. The first successful child heart transplant in the UK was carried out there 20 years ago, and I am happy to tell the House that the young lady is alive and well, living and working on Tyneside.
	Clinical outcomes at the children’s heart unit at the Freeman are excellent. On my visit, I saw artificial ventricular device systems, known as Berlin hearts, attached to very young patients, but, if the unit closed, that pioneering work would move, probably to Birmingham, leaving the whole of the north without provision. There are similar issues with the extra corporeal membrane oxygenation services currently provided at the hospital. The children’s heart unit really is a national resource, with an international reputation.
	No one can doubt the commitment of the senior management and of the trust board to the pioneering children’s cardiac work at the Freeman. The trust has invested in services and, pending the outcome of the review, has a further investment programme ready to go. The review team, in its assessment, has weighted quality, sustainability and deliverability more heavily than access and travel, and that seems to me to be the right prioritisation.
	I want to make two final points. Although this is an England and Wales review, the people of Scotland could also be affected by the outcome, certainly as far
	as nationally commissioned services are concerned. As well as with Scotland, the Freeman hospital has well established connections with Northern Ireland and with the Republic of Ireland, and although I recognise that this was not formally part of the review team’s remit, I welcome its decision to invite observers from Scotland and Northern Ireland to its deliberations.
	My final point echoes the point that the right hon. Member for Charnwood, the Health Committee Chair made, and it is this: I welcome the effort made by the review team and its sponsors to meet MPs yesterday in the House. They made an impressive case for the review itself, and for the thorough and detailed way they have gone about it. We are constituency representatives, each trying to do our best for the communities we represent. Having said that, I believe we should think very carefully before trying to impose our political judgments—based on support for the constituencies that we represent—over the judgments of the health care professionals who have studied the issues in detail and spoken so clearly about the clinical priorities involved for the whole country.

Greg Hands: I very much support the principle that lies behind the review—that we need larger, more sustainable centres with the same overall number of specialists throughout the country. That is why charity and campaign groups, such as the Children’s Heart Federation and Little Hearts Matter, back the change.
	I recognise that people will have to travel further as a consequence, and that will sometimes be extremely difficult, for families in particular, but the choice is between people travelling further and getting the best outcome for their child, and people having a shorter distance to travel but perhaps compromising the outcomes that can be achieved. The clinical evidence is unambiguous: travelling further means that some children will live who would otherwise die. On that basis—the whole basis behind the review—we have to bite the bullet and make change.
	I support the principle of fewer, larger units, but the experience of Royal Brompton hospital in my constituency has made me question the process that is being used to make individual decisions. As my hon. Friend the Member for Pudsey (Stuart Andrew) pointed out, the matter needs to be depoliticised from the outset. The review is taking place at arm’s length from the Government. Indeed, as the right hon. Member for Newcastle upon Tyne East (Mr Brown) said, it was set up under the previous Government and is being administered by a body called the joint committee of primary care trusts, which I assume is up for abolition.
	Phase 1 of the assessment process involved ranking all the existing units on core standards, sustainability, facilities and so on. Great care was taken, and that makes the next phases all the more mystifying. Out of the 11 units ranked, the Royal Brompton came joint fourth, on 464 points. Of the 11 units assessed, only two had the maximum number of four surgeons—the Royal Brompton and Great Ormond Street. In terms of the number of procedures undertaken each year, the Royal Brompton came fourth highest of all. In each of the three objective criteria, the Royal Brompton was in the top four nationally. I therefore asked the joint committee
	of PCTs this question: why bother to rank all the units only then to stipulate that one of the top four has to close whatever else happens? That is the consequence of the decision arbitrarily to rule out keeping three centres open in London. One of the top four units in the country is to be axed, no matter its size and no matter its quality, due merely to its location. That flies in the face of the starting point of the review—that it was all about clinical outcomes, not geography.
	The Royal Brompton has four specialist surgeons who perform 520 operations, including 453 children’s heart operations, per year. It has a fantastic safety record, with an aggregate mortality rate of 0.94 of 1%—less than half the national average of 2%. Why, then, when it is already a model example of what the review wants to create, does the consultation, in all the options available, decree that it must close? The Joint committee of PCTs is claiming that it has an open mind, but in reality it is consulting on four options, all of which would shut the unit at the Royal Brompton.
	The knock-on effects on services elsewhere in the trust would be considerable, especially on children with cystic fibrosis, of whom there are 300 in the country. The future of provision for those children would be extremely unclear. It is also unclear what capacity the remaining two hospitals in London would have to take on—

Simon Burns: I will speak with great care because—he is as aware of this as I am—of the possible judicial review with regard to the Royal Brompton. I would like to say, though, as I think it may help him, that no decisions have yet been made. The consultation literature specifically asks consultees for their views on how many centres it is best to have in London—two or three. If they agree that two is optimal, they are asked to state which two they prefer, including the Royal Brompton. Even though it is not included in any of the pillars, people who are taking part in the consultation process can argue its case, and it will be considered because the JCPCT is taking a flexible approach to the consultation process.

Greg Hands: I welcome that intervention from the Minister. He is right that it is open to the consultation to consider it, as it says on the last page of the consultation document, but the document was contradictory on this point in the first place. On page 84, it says,
	“London requires at least 2 centres due to the size of the population it covers”,
	but in a footnote on page 93 it still imposes the arbitrary limit of two centres at most.
	The joint committee has belatedly recognised a problem. Under pressure, it announced at the beginning of May that an expert panel would be established to review the wider impact on other services if cardiac paediatrics were to close. That was welcome, but it has continued to press ahead with the original consultation and names for the new panel were not proposed until this week. By the time the new panel reports in August, the consultation will have closed. What happens if its response reflects the serious concerns about a whole series of national services? Having consulted on options A, B, C and D, it can hardly go for an option E that no one was asked about. It would then probably have to re-consult.
	I became the MP for the Royal Brompton in May last year, although, as the neighbouring MP previously, I have been very familiar with its work for many years. Its previous MP, my right hon. and learned Friend the Member for Kensington (Sir Malcolm Rifkind), also strongly supports its campaign to fight the proposal. I have visited the hospital three times in the past year. The proposal to end its cardiac paediatrics has been brought to the attention of parliamentary colleagues across all parties and across large parts of London, the south-east and East Anglia. A huge petition has been gathered, signed by more than 30,000 people, and tomorrow we are delivering it to No. 10. I have written at length and in detail to the Secretary of State on the matter, and he helpfully replied—I think this was confirmed by the Minister—that
	“no decisions have yet been made”,
	including on the number of units to be located in London. That is a cause for encouragement.
	I repeat that I support the aims of the review, but the consultation has been badly flawed. Three units in London, perhaps restructured, should have been an option, and the knock-on effects of closing services should have been considered. The case must now be re-examined. The Royal Brompton is good enough, large enough and loved enough to survive.

Jonathan Ashworth: I, too, congratulate the hon. Member for Pudsey (Stuart Andrew) and other members of the Backbench Business Committee on securing this timely debate.
	When I delivered my maiden speech in the Chamber two weeks ago I mentioned my support for the campaign to maintain the children’s heart unit at Glenfield hospital, which, as the right hon. Member for Charnwood (Mr Dorrell), said, is in the constituency of my parliamentary neighbour, my hon. Friend the Member for Leicester West (Liz Kendall). The campaign is supported by my hon. Friend and by my right hon. Friend the Member for Leicester East (Keith Vaz), as well as by many Members from across the county, if not the east midlands as a whole. It is right that this does not become a party political matter.
	Last week, my hon. Friend the Member for Leicester West and I attended the public consultation event on Glenfield at Walkers stadium in my constituency attended by hundreds of concerned parents, dedicated staff and local people, not only from Leicester but beyond the east midlands. Many of those people have never used the unit at Glenfield and, one hopes, will never need to use it, but they were all convinced of the logic of maintaining it. We heard moving stories from parents telling us how outstanding was the quality of care provided to their children. We heard testimonies from many of the staff at Glenfield, who described in remarkable detail the quality of the care that they provide and how they intend to continue to improve it.
	We also heard many people, particularly members of the Asian community, express frustration, if not anger, about the fact that Glenfield features in only one option—option A. Many Members will know that Leicester has a very diverse population. Evidence shows that there is a high prevalence of heart disease in Asian communities, and some of my constituents from those communities
	are particularly concerned that Leicester features in only one option. In the past few weeks, people from mosques, gurdwaras, Hindu temples and the Federation of Muslim Organisations have been very vocal about this.
	I want to focus my remarks on something that is unique and specific to Glenfield: our world-class ECMO—extracorporeal membrane oxygenation—service. An ECMO machine—I have to concede that I am far from an expert on these things, so Members may want to correct me—rests the heart and/or lungs of a patient waiting for recovery. I have been told by many at Glenfield that this procedure was pioneered there 20 years ago. Today, Glenfield has more than 10 machines, and it is no exaggeration to describe it as a world-leading centre in this field. Glenfield is the only centre in the country that provides ECMO for patients of all ages, from newborns to adults. Its expertise has been recognised on many occasions. For example, last year 110 adults were treated during the swine flu outbreak at Glenfield’s ECMO centre.
	How is that relevant to the future of the children’s heart unit? Quite simply, the ECMO service is provided by the same staff who work in the congenital heart centre. Therefore, if that centre closes, Glenfield will lose its ECMO service as well. Of course, the ECMO service could go to Birmingham, as is mooted in the consultation, but that rather misses the point. Many of the staff working at Leicester’s ECMO centre have done so for nearly 20 years. Their combined expertise has helped to make Glenfield’s ECMO unit the world-class facility it is today. Many of my constituents are concerned that it would be years before an ECMO unit could be re-established elsewhere with the same level of competence. Training new staff to have the level of expertise offered at Glenfield could take up to 10 years. That is why many people in my constituency feel that keeping this national service is vital. Giles Peek, a consultant paediatric heart surgeon, told the Leicester Mercury:
	“We use it not just after surgery but also to stabilise children and to stop them dying before surgery. We are almost always full and often take children from other hospitals… Our role at Glenfield as national reference centre for this treatment is important and underestimated.”
	Although I understand that this is a consultation and that it is right that these decisions are made by clinicians and not politicians, I hope that the joint committee will consider further options because of the expertise at our ECMO centre. Many of my constituents would be grateful if the Minister reflected on the national implications of Glenfield losing its ECMO centre and, at an appropriate time, made some remarks about that.

George Mudie: I hear what the hon. Gentleman says. I think that the same case was made by the right hon. Member for Charnwood. We may prevaricate for one reason or another, but sometimes it may be necessary to make a decision even when we think that it is not perfect, and I think that this is an instance of that. If the life of a child is involved, we must make a decision.
	If we continue to challenge the clinical aspect of the review, we will fall into the trap of allowing a bad situation to continue. The case for change has been proved, and, while we may differ on how that change should be made, what is important is for us to express the view—and I should like to see it challenged—that there should be equality of access. Each region should ensure that every part of it has equality of access where possible, although that will involve some difficulty if Yorkshire is lumped together with the north-east.
	In the last year I have had to move from my constituency office, which was in the centre of the constituency. I was offered cheaper, perhaps even better, accommodation in the outer part, but I felt that it would be unfair on the other wards for me to move away from the centre. If option four is either Leeds or Newcastle, I think that that is unfair on both. I do not want to close Newcastle, and Newcastle does not want to close Leeds. Locating provision sensibly in each region is important, but the House should also recognise, as it rarely does, that the country has some corners in which there is no equality of access in any respect. Those in Newcastle, in the top corner, and those in Cornwall, in the bottom corner, do not have access to many facilities that are accessible to people in the midlands, in Yorkshire and, above all, in London.
	I believe that the House should accept the motion, and that the review team should forget about the clinical arguments and produce a template that proves to every Member that the excellent services that we should be demanding for children’s care will be shared equally around the country. The team should give some real, positive, out-of-the-box thought to how to deal with areas that generally lose out.

Stuart Andrew: My hon. Friend mentioned the co-location of services. As I mentioned in my speech, Leeds has spent considerable time ensuring that all children’s services are under one roof. If we lost the heart unit there, might not other services be affected as well?

Greg Mulholland: I have not yet had a chance to congratulate my hon. Friend on the way in which he has co-ordinated our campaign. It has been a pleasure to work with him so closely, and I look forward to continuing to work with him and other colleagues. He is right: one of those serious flaws is the failure to consider the impact on adult heart services, which would be a huge problem.
	There is real concern out there, as has been demonstrated not only by the petition in Yorkshire and petitions in other parts of the country, but by the views expressed by many respected practising and retired clinicians. The concern about the closures is understandable, but there is also concern about the review itself. There is concern about the process, about the conclusions reached so far, about the lack of consistency in the recommendations, about the lack of logic in relation to the premise of the review, and, I am sorry to say, about a lack of impartiality.
	That is why it is right for the House to have an opportunity to express that concern on behalf of all the areas concerned, and why it is fitting that the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), is present. I thank the Minister for the way in which he has engaged with us, and I urge Members in all parts of the House to support the motion, so that we can address the concern that has been expressed outside and inside the House by considering the possibility of other configurations.
	I wish to echo three points that have been made about the wonderful Leeds unit. The first is about the co-location of services. The unit is a case of true co-location, which is what the British Congenital Cardiac Association has called “gold standard” care. Leeds is currently one of only two hospitals shown in the review to have such a type and level of service. Mr Joe Mellor, a consultant anaesthetist at Leeds, says:
	“What is particularly upsetting about the proposals is that our patients from Yorkshire would leave the Leeds unit and have to travel to Newcastle or Leicester. Leeds has centralised all its children’s services onto one site. Neither Newcastle nor Leicester have come close to achieving this. Congenital cardiac surgery is a very complicated form of medical treatment. If in Leeds we encounter a problem where the child needs the help of an intestinal surgeon, or a neurosurgeon, or need renal therapy, or a host of other possible therapy, then we get it immediately in our own children’s hospital.”
	Jonathan Darling, a consultant paediatrician at the Leeds general infirmary, states:
	“To lose heart surgery from the Leeds Children’s hospital would be a huge blow, especially when we have just centralised services precisely to realise the benefits of having all paediatric services co-located on one site. The Review process does not seem to give sufficient weighting to this true co-location.”
	I am afraid that it simply has not done so, which is worrying and quite extraordinary.
	The second point that I wish to make is on the issue of population, which colleagues from the region have already raised. It simply makes no sense to close a wonderful unit that is already performing almost the number of operations that it must, when there are so many people in the area and the population is growing. I echo the comments of the hon. Member for Leeds East (Mr Mudie) when I say that of course we do not want to see the Newcastle unit close. We do not want to see any unit close, because this is about getting things right. However, I say to him and others that it would be absolutely perverse to close Leeds simply to enable Newcastle to perform a sufficient number of operations. If we stick to the number in the review, Newcastle can only perform that number of operations if Leeds closes. That is absurd.

Andrew Turner: I shall confine my speech to issues that uniquely affect my constituents. The Safe and Sustainable consultation is fundamentally flawed. Three of the four options envisage the closure of the Southampton centre. Those options are based on wrong assumptions and inaccurate data. Let me set out the background. The consultation document states:
	“All options must be able to meet the minimum requirement to collect a child by ambulance…within three hours of being contacted by the referring unit”.
	It then examined “detailed access mapping” using train and road journeys—that is important—and considered how existing networks were affected. More options that did not meet the “three hours” criteria were ruled out. Bristol is included in “all viable options” because south-west Cornwall and south Wales are more than three hours away from either Southampton or Birmingham.
	Unfortunately, nobody in that expert team seems to have noticed that people cannot travel by train or road from the Isle of Wight. There is a clue in the name: it is an island, separated from the mainland by the Solent. I have said before that the ferries provide lifeline services for my constituents, but in this case that is literal. The error in the data was that because we must cross the Solent by ferry, the island is more than three hours away from either Bristol or London.
	In May, that was pointed out to Mr Jeremy Glyde, the programme director of the Safe and Sustainable review. A statement issued on 3 June said that the team
	“based retrieval times between the island and the mainland on travel by air. This was an oversight”
	because the policy is
	“to retrieve children from the Isle of Wight by road and ferry”.
	That is very odd, because the consultation document explicitly states:
	“Air travel has not been considered because it cannot always be relied upon”.
	The statement goes on to say that
	“an ambulance must reach the referring hospital within 3 hours, or within 4 hours in ‘remote areas’”.
	The conclusion was that
	“it is sensible to measure retrieval times to the Isle of Wight against the threshold for ‘remote areas’.”
	On remote areas, the consultation document states:
	“Removing surgery from some centres could have a disproportionate impact on children in some remote areas because ambulances would not be able to reach the child in three hours or less”—
	meaning three hours or less from Southampton in my case.
	On 3 June, Mr Glyde did not say why the Isle of Wight suddenly became a “remote area” when previously it was not. I am sure it did not move without me or any of the other 130,000 residents noticing. I asked Mr Glyde to point me to the guidelines that determine when an
	area is designated as “remote”. He told me that it was a “subjective interpretation” and that the review board recognise that the island,
	“by its very nature, is remote from the mainland”.
	Of course, that is accurate, but the board should have noticed earlier. After starting the consultation and working on it for years, it suddenly struck the board that there are
	“unique factors around retrieval times by ferry”.
	My Glyde was very helpful. He explained:
	“We have been able to generate potential scenarios that could enable the ambulance to meet the standards”.
	They did so not by using the “three hours” standard set out in the consultation, but by deciding that the “four hours” will apply to the newly remote Isle of Wight. It may be possible to generate scenarios in which an ambulance from Bristol or London can get to the island in four hours. I can generate some scenarios in which I become Prime Minister. Neither possibility can be entirely ruled out, but they do not reflect what is likely to happen in real life—[Hon. Members: “No!”]
	Putting aside my political future, let us examine some realities. The AA route planner shows that it takes two hours to get to the other side of the Isle of Wight, and an hour at least—

Catherine McKinnell: The hon. Gentleman has put his thoughts and concerns on that issue on the record.
	I mentioned the intentions of the Safe and Sustainable review, which was instigated by national parent groups, NHS clinicians and their professional associations. Those intentions must be the primary drivers in deciding the final outcome of the review.
	I am equally concerned at suggestions that the decision and outcome of the review should be stalled, or that the remit should be altered. I am not alone in expressing such concerns. The Children’s Heart Foundation argues that that would leave
	“the door wide open for another Bristol Baby tragedy”.
	Meanwhile, the charity Little Hearts Matter believes that the Safe and Sustainable service reconfiguration offers—

Stephen Twigg: I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing this important debate. I have the privilege to have in my constituency the hugely impressive and world-class Alder Hey children’s hospital, which I am delighted is included in all four options in the motion. I would express some concern, however, were the motion to be agreed to and were we to go beyond those four options. I hope that Alder Hey would be included in any further options that the joint committee would consider and consult on.
	Alder Hey’s cardiac unit treats children with all forms of heart disease, not only in Liverpool and the wider Merseyside area, but those travelling from the wider north-west of England, north and mid-Wales and the Isle of Man. The total catchment area for children using Alder Hey’s cardiac unit covers about 7 million people, so many people already travel very long distances to use the excellent services there. Since 2006, the hospital has treated more than 4,000 patients for cardiac conditions and performed surgery on more than half of them. I spoke to the hospital this week in anticipation of today’s debate, and it expects that the concentration of surgery at Alder Hey will further increase demand, and has built that into its current plans. Alder Hey is on track to have a brand new hospital with a children’s park. The plans are very exciting and have got a strong commitment from the local community in my constituency in West Derby. The hospital is strengthening its services. For example, it is investing in the existing team to add a sixth cardiologist and an eighth intensivist, increasing its theatre capacity to enable the delivery of 637 cases per year, and it has already achieved the minimum required activity for this operational year of 447 cases.
	Members have spoken about the balance between our responsibilities to consider the national picture and our constituency responsibilities. Happily I am in a position to argue that the proposals work both in terms of national policy and for my constituents. The Children’s Heart Federation has highlighted some of the benefits of the Safe and Sustainable review’s proposals, which have been mentioned by hon. Members today: minimal cancellations and short waiting times for surgery; better outcomes from surgery; and an end to high-risk rotas in which a surgeon in a small team covering for a colleague on leave can operate all day and be on call all night
	several days running. As has been pointed out, these changes have been put forward by clinicians, and I would urge the House to tread with great care in jeopardising the outcome of such a clinician-led review. We must remind ourselves that the review does not propose the closure of any centres, and would instead concentrate surgery in the centres where it can be performed safely.
	I finish with a broader point that the Minister might like to reflect on. This review is a good example of evidence-based policy making in the NHS. Perhaps we can have more of that as the process of NHS reform moves forward.

Alan Whitehead: Southampton children’s services are located at Southampton general hospital, right in the middle of my constituency. The hard work undertaken by the large numbers of people who organised the petition presented at No. 10 yesterday—I and a number of fellow Members from across south-central England managed to get ourselves very wet helping to deliver it—showed not partisan fighting on behalf of a particular unit, regardless of its quality or the service that it represents, but genuine mystification that the process appears to have dealt so peripherally with Southampton’s role in the national roll-out of services. In 2010, Sir Ian Kennedy rated Southampton as provider of the highest quality service outside London, rating it particularly highly on paediatric intensive care and support for parents, and highly on training and innovation.
	That mystification as to why such a unit should feature in just one of the options in the review was
	compounded by an examination of the background to that review. Indeed, perhaps the explanation for why Southampton appears to have been treated so peripherally can be found in the review itself. Of course it is important that the review should be completed, that changes should be made and that judgments be made on clinical grounds. However, I would suggest that it is not on clinical grounds that anyone should have forgotten that the Isle of Wight exists. That is the province of geographers rather than clinicians. If clinicians depend on the material in a review setting out the factors that will be taken into account in their final decision, much of their power in making that decision could be overthrown by what goes into that review in the first place.
	It is not a clinical decision for the review to state that Southampton has two surgeons and undertakes 231 procedures, when in fact it will have four surgeons by this summer and undertake almost 400 procedures, as a result of, among other things, its excellent collaboration with Oxford, which my right hon. Friend the Member for Oxford East (Mr Smith) mentioned earlier, but which the review appears to neglect. If such a decision is made by the review, which appears to have got so many things wrong about the background to Southampton’s excellent services, the 250,000 petitioners who signed the petition that went to No. 10 yesterday will justifiably feel let down by the process, whoever conducts it. The national health service has a long and honourable record of stitching people up for the right reasons. If as a result of the review those 250,000 people end up feeling stitched up for the wrong reasons, they will have every right to feel very aggrieved indeed.

Simon Burns: I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on securing this debate on the review of children’s heart surgery services. He has a strong record of campaigning on this issue and of bringing the concerns of his constituents to the attention of the House. I also congratulate him and the other hon. Members on the motion they tabled. The Government and I wholeheartedly support its contents, and I urge other hon. Members to do so as well.
	I should also like to take this opportunity to pay tribute to the dedicated NHS staff who work in children’s heart services in my hon. Friend’s constituency and across the country. They do a tremendous job, for which we are all incredibly grateful, more often than not in complex and difficult circumstances.
	I should like to confirm that the review is totally independent of the Government, and that it is clinically led. It is not driven by me, by other Ministers or by the Department of Health. It is therefore not appropriate for me to comment on the specific hospitals consulted
	during process. I do not wish to act, or to be seen to act, in a way that could influence or prejudice the process that is going on. As many hon. Members have said, this is a highly emotive issue, particularly for those whose children’s lives have been saved by the services under review. It is worth reminding ourselves why the review was conceived and planned and is now being carried out.
	This is not a new issue. The provision of children’s heart surgery has been a cause for concern since the Bristol royal infirmary inquiry in the late 1990s. Understandably, there has been considerable pressure from national parents groups and professionals to ensure that children receive the best treatment, and the sole purpose of the Safe and Sustainable review is to ensure that children with congenital heart problems receive the best possible care now and long into the future. To do that, we must be certain that the centres in which surgery takes place are as good as they can be.

Greg Mulholland: We all understand the premise of the review about the need to move to larger centres, but does the Minister not understand—I am not trying to draw him—the real concern when Leeds is performing 370 procedures a year and Newcastle, a smaller unit, performed only 255 last year, yet Newcastle is in all four units and Leeds only in one?

Simon Burns: I am grateful to my hon. Friend for raising that issue, and I will address it later in my speech.
	No decision has yet been made about which centres should continue to undertake surgery. That decision will be made only after the responses to the consultation have been properly and fully considered. The chair of the joint committee of primary care trusts, Sir Neil McKay, has made it clear that it is a genuine consultation and that all viable proposals will be considered, and I agree with that. There has been no pre-determination of the number of centres that will be selected. Rather, the review remains flexible and open-minded as to the final number and is happy to listen to all options that would produce the excellent clinical outcomes for our children that we desire.
	As I have said however, this review is being driven by a powerful clinical imperative. The trend in children’s heart care is towards increasingly complex surgery on ever-smaller babies. That requires surgical teams that are large enough to provide sufficient exposure to complex cases, so that surgeons and their teams can maintain and develop their specialist skills. Larger teams also provide the capacity to train and mentor the next generation of surgeons. In recent years, other countries have recognised the clinical necessity of larger surgical units and have reconfigured their services along the lines proposed by the Safe and Sustainable proposals. Here in the United Kingdom, there are successful precedents for centralisation. In the past 15 years, the congenital cardiac services in
	Cardiff and Edinburgh have ceased heart surgery on children, as they recognised that their centres were just too small to be sustainable.
	I also want to reassure Members on the integrity of the process that was followed in developing the options for consultation. In the past, concerns have been put to me in this House about mistakes in the assessment process, particularly relating to the Leeds service, and Members have referred to that again today. I understand that since our last debate in February or March of this year the chair of the joint committee, Sir Neil McKay, has written to the chief executive of the trust in Leeds to explain why mistakes have not been made in relation to the Leeds centre.
	Members, including my hon. Friend the Member for Skipton and Ripon (Julian Smith) in his recent intervention, have also raised the issue of documents not being made available in a sufficiently wide range of languages, thereby excluding those who speak those languages from the consultation process. The relevant documents have for several weeks been available in 10 different languages, including Urdu, Arabic, Farsi and Punjabi. [Interruption.] The hon. Member for Leicester West (Liz Kendall) shakes her head, but I assure her that they have been available for several weeks, although I accept that they were not available from the first day of the review. That may be the point the hon. Lady was seeking to make, and I agree with her if she thinks they should have been from the first day. We cannot change the fact that they were not available from then, however, but they have been available from, I believe, 20 May, and the consultation process runs until 1 July, which gives sufficient time for people who need to access the documents in those languages to do so and to be able to input their views.
	I hope to be able to reassure my hon. Friend the Member for Isle of Wight (Mr Turner) on retrieval times and access times from the Isle of Wight, given its unique geographical situation. It is my understanding that the joint committee of primary care trusts has agreed that Southampton University Hospitals NHS Trust has provided evidence on this issue that requires further consideration and has invited the trust to develop a detailed case regarding retrievals from the Isle of Wight, which the committee will consider as part of the evidence to determine the optimum reconfiguration.
	Several Members raised the issue of the inclusion of black and minority ethnic communities in the consultation process. There have been a number of workshops and focus groups, many of which have been aimed specifically at the BME communities. Almost 2,000 community groups and organisations that have an interest in BME issues have been contacted and invited to take part in the proceedings. Public meetings have been arranged, particularly in Leeds, specifically for the Asian population of Yorkshire in partnership with representatives of local BME groups. The Leeds meeting is on 29 June, there is a meeting planned for Bradford on 30 June and a further meeting is planned for Kirklees. I hope that hon. Members who represent parts of Yorkshire and the surrounding catchment areas will be assured by that.
	To abide by your rules, Mr Deputy Speaker, I will now conclude by saying that I am confident about the consultation. Everyone will accept that all consultations of this nature can be difficult, when tough decisions have to be taken. The decisions have to be taken for the
	right reasons, based on clinical evidence about the best way to improve and enhance care and the quality of care for patients. That is particularly true in this case because more often than not the patients are very young children with very complex needs—that is what makes this issue so difficult.
	Let me reiterate that no decisions have been taken or will be taken until the joint committee has had an opportunity to consider the independent analysis of the consultation responses, reports from any local overview and scrutiny committees and a health impact assessment. Throughout, it will remain open-minded and flexible as to the number of centres. The only important consideration will be the sustainability of clinical excellence at the centres chosen. I doubt whether this is the case, but if any hon. Members have not taken part in the consultation I urge them to do so. I also urge them to ensure that their constituents and organisations in their constituencies with an interest in this matter take part in the consultation if they have not already done so, so that the committee can have the widest range of views, information and opinion before reaching what will, in any circumstances, be difficult decisions.

Nicholas Dakin: It is a pleasure to follow the Minister, who was very careful in setting out how he is attempting to ensure that this process proceeds in an appropriate way. I was pleased by his comments about the consultation being genuine and about the review being flexible, open-minded and not limited to a particular set or number of outcomes. His contribution was very reassuring and I thank him for that.
	I would like to use as my reference point a lady who attended a meeting in Scunthorpe, at the Wortley House hotel, for people who have used the Leeds children’s heart unit’s services in recent years. Her use of the service goes back to when it was in Killingbeck hospital a long time ago before it moved to Leeds general infirmary in 1997. At that point, as has been pointed out, all children’s services were located in one area to great positive effect for the children of the Yorkshire and Humber region. What she said to the people from Leeds at that consultation was that she really did not mind where the heart surgery locations were, but that she wanted the very best to be delivered for children in need so that they could access the best and most excellent services. She went on to say that her experience of the Leeds service was such as to give her assurance that it would meet those needs. She was particularly concerned that proper outreach services should remain in any future configuration. Her daughter was expecting another child and was already engaged, in relation to her pregnancy, with service support through Leeds, which was going to make it less likely that there would be significant cardiac problems that could not be dealt with at the appropriate time and with appropriate effectiveness.
	In the Scunthorpe area, we tend to be on the periphery of things, so we always have to travel, in this case to Leeds. The weather conditions at the end of last year made it difficult to travel to and from Scunthorpe, and a two-hour journey with unwell youngsters would have led to great concern.
	We need to make sure that there are proper outreach services to give support in future and, as my hon. Friend the Member for Leeds East (Mr Mudie) said earlier, we must recognise that people should have equality of access to excellence wherever they are in the country. That is important for my constituents.

Nicola Blackwood: I, too, congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on his leadership in securing the debate. I open my remarks by paying tribute to Oxford’s paediatric cardiac team, including Professor Steve Westaby. The team have saved countless lives and have the complete confidence of the patients and families who have asked me to speak up for them today. I also pay tribute to the Young Hearts charity, which has stood up for children with congenital heart disease and their families in Oxfordshire and presented a petition, which I am holding in my hands, with thousands of signatures to the Prime Minister in his constituency this month. They have done much to assure services in Oxfordshire.
	Few would take issue with the basic aims of the Safe and Sustainable review; who does not want to improve outcomes for children with congenital heart disease? That is not where the concerns lie. The review works on a simple premise: more surgeons doing more surgeries will achieve better outcomes for more patients. That makes perfect sense, but in this instance, as the motion states, size is not everything. Although the simple centralisation of specialist services is backed by clinical evidence, some clinicians in Oxford, Southampton and elsewhere are of the opinion that it draws on too narrow an evidentiary base and that matters such as the co-location of services, assessed travel and population projections must also be considered.
	On co-location, for example, a 2008 Department of Health report states that cardiac surgery requires the absolute co-location of paediatric cardiology, paediatric critical care, specialist paediatric anaesthetics, specialist paediatric surgery and specialist paediatric ear, nose and throat services. Even though Safe and Sustainable states that the co-location of those services should be mandatory, it is not clear how the four proposed options meet the standards of the framework of critical interdependencies or, for that matter, the standards of Safe and Sustainable itself. I hope that the Minister will note those grave concerns, which patient groups, families and clinicians have expressed, and will ensure that the joint committee of primary care trusts takes the process forward, clarifying the issue of the co-location of service and properly and transparently communicating that clarification to those groups.
	A child with congenital heart disease does not exist in isolation. He or she is cared for tirelessly by family
	members who have to make terrifying treatment decisions, and by siblings who have to accept that home life is on hold while parents go to and from hospital and everyone concentrates only on keeping that child alive. That is what parents do for their children. It is what they sacrifice and do without hesitation, because nothing matters more than bringing that child home again, happy and healthy, so that everything can get back to normal. No matter how freely they give that care, however, caring for a child with congenital heart disease puts massive stresses on parents and siblings, and the outcome of the review should also try to relieve that pressure, if at all possible.
	That is not just a moral argument; paediatric patient outcomes improve when carers cope better. I know that Ministers believe that the best possible surgical outcome is the best way to help families, but families who come to see me are worried that they will not be able to get to the hospital for the surgery in the first place; that there will be longer waiting lists; that they will not have continuous care under surgeons whom they can trust with their child’s life; that staff at units that close will not be able to move to those that scale up; that we will lose dedicated people from the NHS; and that there will be a shortfall in service while new staff are trained up. All those concerns are just as valid and significant as ensuring that the surgeon has the necessary skill once he gets the patient on to the operating table.
	The irony is that, while the Safe and Sustainable options are causing that concern, Oxford and Southampton already have an option that is working as we speak. The south of England congenital heart network offers the quality guarantees of an increase in clinical team size and patient base which Safe and Sustainable seeks, while creating and retaining the continuity of care and patient access that local clinicians and patients fear losing. That network was developed and is led by clinical teams at Oxford and Southampton; it has five congenital heart surgeons and nine consultant paediatric cardiologists; and it is the first time that two teaching hospitals have collaborated to provide joint tertiary clinical service.
	That is exactly the kind of networking arrangement that Safe and Sustainable aspires to create, but the network puts the patient first, not the surgeon. It makes the best use of existing services but does not require extensive restructuring of human or physical resources; it addresses the problems of waiting times, travel times and co-location which Safe and Sustainable has failed to address; and, most importantly, it has been tried and tested for more than a year.
	There is a risk that Safe and Sustainable will be seen as a top-down, inherited review, so a locally innovative system such as that network, which is supported by local heart groups, supported by local clinicians and clinically driven, is something that the Government should seek to support.

John Glen: In view of the time, I will be as brief as possible. I thank my hon. Friend the Member for Pudsey (Stuart Andrew) for initiating this debate, and I thank my hon. Friend the Member for Winchester (Mr Brine), who has provided much sound advice and support as we have brought this case to the House.
	Two issues about the calculation of quality have come to my attention through my constituents Joanne Diaper and Richard Maguire. Southampton scored extremely well, but I am concerned about the differences between the various hospitals and how they have scored. If there is a range of difference of up to 20% on outcomes, I am concerned that the review could institutionalise mediocrity, not excellence.
	There is a consensus throughout the medical world that, as the Children’s Heart Foundation chief executive says,
	“the majority of parents recognise that paediatric cardiac surgery is a specialist service,”
	and that there will need to be some rationalisation nationally. She goes on to say that parents
	“support the concept of larger but fewer centres of excellence”—
	not of centres that are quite good but could become better over time. Given the complexity of the procedures that need to be undertaken, it behoves those reviewing the decision to note excellence and to embed it in future provision. We need to drive up standards in areas that do not have excellence.
	Some clinical experts may move to the other side of the country, or perhaps to another country altogether. Most parents of chronically sick children with conditions that can be treated only by two or three specialists will travel any distance because they want to know that they have the best chance of having their children’s lives extended. The motion makes a sensible case in recognising the need for partnerships, and I welcome the partnership that exists between Southampton and Oxford.
	It was announced in the Safe and Sustainable pre-consultation business case that 400 surgeries constituted a minimum threshold, but the mix could be extended to include surgery on adults as well as children. It is vital to look at what is clinically the right thing to do instead of imposing a threshold that seems convenient but does not do justice to the skills that exist in individual hospitals.
	In the interests of time, I will now conclude my remarks to allow some of my colleagues to make, I hope, some different points.

Alec Shelbrooke: I will try to be brief to allow as many of my colleagues as possible to speak.
	I do not want to take up too much time in defending the case for Leeds because that has been done exceptionally well by many others. Like me, a good number of the Leeds MPs who now occupy this place were city councillors there, including my hon. Friends the Members for Leeds North West (Greg Mulholland) and for Pudsey (Stuart Andrew) and the hon. Member for Leeds East (Mr Mudie)—a distinguished leader of Leeds council who was very much involved in achieving our aim of having the children’s hospital all in one place. As Leeds councillors, we had personal experience of this matter when one of our colleagues died of heart disease in his early thirties. He was from the black and minority ethnic community, which makes up 23% of the population
	of Leeds. Sadly, that community has inherent heart problems. That has been overlooked, and it needs to be given weight in the review.
	We have heard about many of the flaws in the review. The Minister rightly says that he does not have any influence over the review, which is independent, and as individual MPs we probably do not have much influence over it either. What we do have, however, is this place. Twenty-four hours ago, we were knocking nine bells out of each other. It was raucous and it was fun; we made some serious points and we were having a go. Today, from across the Chamber, some very serious speeches have been made. No matter which side of the House we are on, politics does not come into it. This House is speaking as with one voice, and that voice should be heard by the people carrying out the review.
	When Members of a House such as ours, which can be so confrontational, all come together, that shows the real power of our parliamentary democracy. Although the Minister, and we as individuals, may not have any direct influence on this process, it would be extremely foolish for the people involved not to take note that we will almost certainly not divide on the motion and that we all support it, including the Minister himself and the Government. My constituents are always asking whether we can work together, and we can. Everyone has come together to say that the House of Commons says that the review needs to be looked at again and other options need to be developed. That is a powerful message that I want to go forth to the people who are carrying out the review.

Caroline Nokes: I add my congratulations to my hon. Friend the Member for Pudsey (Stuart Andrew) on securing this debate. I thank the Minister for his important comments on and support for the motion.
	I feel strongly that there should be a change in the configuration of children’s cardiac surgery, but it must create the right configuration. We want the correct answer to the question, and we want the review team to listen to all the arguments and make its decision based on the best possible evidence. I argue strongly, representing as I do part of the city of Southampton, that when we are looking at the important issue of children’s cardiac surgery, we must base our decision on quality.
	I have been in regular contact with a constituent of mine, Mr Jim Monro, whose name will be familiar to all Members who have investigated this matter because he is one of the country’s most eminent cardiac surgeons. He is now retired. He first conducted a review into children’s cardiac surgery after the tragedies in Bristol in the 1990s. He feels strongly that he has seen this matter kicked into the long grass for too long. We must crack on and ensure that the review is completed. However, it must take into account the best available evidence and come up with the right outcome. None of us wishes to see a recurrence of the dreadful tragedies in Bristol. That is where the roots of the review lie.
	Although I support the need for the review, I do not endorse the process, nor the recommendations in their entirety. I question three elements in particular. Fundamentally, the review must be about quality. We have to ensure that the best outcomes are achieved for
	the very sickest babies and children. However, the Southampton unit, which has a superb record of outcomes, finds itself in only one option—option B, the so-called quality option. I cannot believe that that is right for one of the highest performing units in the country. It carries out difficult procedures, does not cherry-pick cases where the best outcomes are likely, has proved that it can work collaboratively with Oxford, is widely acknowledged to be one of the best units in the country, and already has three surgeons, with a fourth starting shortly. I have heard colleagues describe it as a perverse outcome that one of the country’s top performing units is included in only one option, in which postcode matters more than the life chances of the sickest babies.
	Secondly, and I will not rehearse this argument at great length, there is the additional complication of the Isle of Wight. My hon. Friend the Member for Isle of Wight (Mr Turner) has informed us of that issue clearly. People from Southampton want an answer to that question. Six weeks ago at a consultation meeting, they were promised that more information would be forthcoming from the review team about how significant the Isle of Wight factor was. We are still waiting.
	Thirdly, the manner in which the consultation is being conducted has created an adversarial climate in which cardiac unit is put against cardiac unit and surgeon is put against surgeon. I feared that today we would see MP against MP, but we have not. As my hon. Friend the Member for Elmet and Rothwell (Alec Shelbrooke) said, this has been a collaborative debate that has picked up on the strengths of each case.
	I welcome the spirit in which this House has responded to the motion.

Julian Sturdy: Like many Members, I have a local heart unit that I shall seek to defend. However, before discussing the merits of retaining the Leeds unit, it is important to acknowledge the wider context of the debate.
	I strongly believe that the Safe and Sustainable review is a necessary and genuine exercise. Its aim is to ensure that the highest possible level of surgical care is provided to each and every affected child, regardless of where they live. There is no doubt that the case for change is medically accepted. Nevertheless, I believe that decisions over the potential closure of local health services cannot and should not be taken lightly. In light of the huge amount of evidence behind the motion, I urge the review’s steering group to take as much time as possible in considering the performance, locality, capacity and strength of each unit, among other factors.
	On the basis of those four criteria, I strongly believe that closing the Leeds unit would be a huge mistake. The first and most important factor is performance. Leeds general infirmary is at the forefront of work on cardiac conditions. All the relevant reviews and statistics highlight its record of excellence in providing safe and high-quality children’s heart surgery. An important contributing factor in that excellence is the centralisation of the whole children’s services operation at the site in Leeds. However, the review document contains discrepancies when it comes to the definition of co-location of services. To me, co-location means all children’s services operating on a single site, and Leeds is one of only two hospitals cited in the review that offer that gold standard.
	The second principle is locality. The unit is within two hours’ travel time for nearly 14 million people, including 5.5 million in the Yorkshire and Humber area. In such highly populated areas, surely the focus should be on delivering services to the people and delivering them to the greatest area of need, not vice versa. In my view, the location of the unit and the huge number of children whom it serves make its continued existence imperative.
	The review document states that parents need not accompany their children. I have two young children myself. What parents would not want to accompany their children in such difficult circumstances? Sadly, however, that is not always possible. There are child care arrangements to be made, and work issues and transport links to be considered. The stress of all that is extremely disturbing for all families in such circumstances. I realise that that applies to all the centres, not just Leeds, but I believe that we must take account of the core principles: the need to deliver services to the people, and the need to provide easy access for as many as possible. That means locating services in highly populated areas with good transport links and travel times. Birmingham and Liverpool have been included in every option in the review, and rightly so, but why has Leeds not been identified in the same way on the basis of those core principles?

Damian Hinds: The review document is called “Safe and Sustainable”, and that is absolutely the right title for it. It is worth repeating what has been said by every speaker today, and by the clinical leadership of the review: this is about saving lives, not about saving money. We must bear in mind the link between scale and quality and between quality and safety. The “scale” factor applies to the level of the number of procedures per surgeon per year and to the number of surgeons per unit. The challenge was summed up best by the statement from the Royal College of Surgeons, to which the right hon. Member for Oxford East (Mr Smith) referred, that although the country has the right number of surgeons carrying out these complex operations, they are too thinly spread. Change is clearly needed.
	Coincidentally, in the last three weeks my family has had occasion to rely on the paediatric intensive care units and surgery at Southampton General hospital, in the constituency of the hon. Member for Southampton, Test (Dr Whitehead), where we benefited from outstanding care. This was not heart surgery, but the experience gave me plenty of cause to reflect on the value of not just convenience and location but, above all, quality of care. In such circumstances, families will do what they have to do, although it may be very difficult, and will find a way of securing care of the highest quality. The experience also taught me something about the interconnection between services.
	All the criteria set out in the review document have a role to play, but in my view the most important criterion of all must be quality, and I do not think that that comes across as much as it should in the review. How can it, given that the centre that is ranked second out of the 11 in the country for quality appears in only one of the four options? The question also arises, in the context of Southampton General hospital, of whether—given
	the role of scale and quality—sufficient consideration has been given to the most recent trends since the suspension of paediatric cardiac surgery at the John Radcliffe hospital.
	Other factors have also not been given sufficient weight. First, there is the requirement for co-location of paediatric surgery with other essential services for children. Secondly, there is the impact on paediatric intensive care units, paediatric intensive care retrieval, and the other networks mentioned by the right hon. Member for Oxford East. Thirdly, there are the implications for services that provide longer-lasting care for people with cardiac conditions from birth to adulthood.
	Our objective must not be to stall or jam the process, because there is a need to reduce the number of centres. We must avoid the politician’s tendency to say that of course we agree the general principles of the review, except in the particular circumstances that apply to our own constituency. I hope I have not done that, but I do think that Southampton has a particularly strong case based on the excellence of its clinical record. I strongly support the drive for us not to be restricted only to the four options in the review, considering the additional evidence that has come to light during its course.

Andrew Percy: Outrageous, Mr Deputy Speaker! But obviously accepted.
	I associate myself with many of the comments of my fellow Yorkshire and the Humber MPs, particularly my near neighbour the hon. Member for Scunthorpe (Nic Dakin). I want to mention a couple of issues raised by our local health trust, which is opposing anything other than option D very strongly. Indeed, North Lincolnshire council’s scrutiny committee met to discuss the matter on Tuesday and similarly supports that option, which would help to maintain the Leeds unit. That is not simply because it is our local centre. My constituents have to travel a considerable distance to get to Leeds, as it is not exactly next door. It is okay for some of us, but it is quite some distance for my constituents over in Brigg, in particular.
	My constituents accept the regionalisation of health services when it is of proven benefit. That is so in the case of adult cardiac services, which are currently provided in Hull, and the same applies to children’s cardiac services. However, if we are to go down the route of regionalisation and big centres, it seems sensible to put services where the population is rather than try to move the population to where the clinicians are.
	I wish to quote a couple of points that my local health trust has made. It has stated:
	“Leeds has the largest population centre and therefore it is most sensible to ask fewer patients to travel the least distance”.
	As I said earlier, the conclusion of the North Lincolnshire and Goole Hospitals NHS Foundation Trust was that it believed babies, children and families in north Lincolnshire would largely be disadvantaged in their access by the proposed changes.
	I am aware of the very short time available, so I cannot say most of what I would have liked to say, but my final point is that under the proposals we could end up in the rather odd situation that some of my constituents could be served by one centre and others by another. Given that they are all in the same health trust area, that could mean different services being provided to different constituents.

Liz Kendall: It is a real privilege to take part in today’s debate, and to follow the thoughtful, moving and at times passionate speeches of Members of all parties. I thank the Backbench Business Committee, and I particularly thank the hon. Member for Pudsey (Stuart Andrew) for securing the debate.
	Like the right hon. Member for Charnwood (Mr Dorrell), I wear two hats today. As the Member for Leicester West, home of Glenfield hospital’s superb congenital heart centre, I know how important the review of children’s heart surgery is for my constituents, as it is for those of each of the hon. Members who have spoken. As the Opposition spokesperson, however, I am also well aware of my national responsibility, and that of the House, to ensure that every child gets the very best quality of care.
	I want to start by making the case for change, as did other Members including my hon. Friends the Members for Liverpool, West Derby (Stephen Twigg) and for North West Durham (Pat Glass), my right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown) and my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell), who made brave and courageous speeches.
	Following the devastating findings of the Bristol Royal infirmary inquiry almost 10 years ago, clinicians and professional bodies have been clear that children’s heart services need to change to ensure that every child gets the best standard of care now, and crucially also in the future. They include the Royal College of Surgeons, the Royal College of Nursing, the Royal College of Paediatrics and Child Health, the Society for Cardiothoracic Surgery, the British Congenital Cardiac Association, the Paediatric Intensive Care Society and many others.
	The reason why services need to change is that children’s heart surgery is becoming ever more sophisticated. Technological advances mean that care is increasingly specialised and capable of saving more lives and improving outcomes for very sick children. However, services in England have grown up in an ad hoc manner. As my right hon. Friend the Member for Oxford East (Mr Smith) said, surgeons are too thinly spread. Care needs to be better planned to pool expertise in specialist centres so that all children get excellent quality care. I therefore welcome the Safe and Sustainable review, which was initiated by the previous Government. The challenge, as the House has rightly demonstrated today, is to ensure that the right aims, objectives and criteria drive the review, and, crucially, that they have the right weighting and that the right balance is struck.
	Of course, improving the quality of care must be our primary concern. The review rightly calls for fewer, larger surgical centres to provide 24/7 consultant cover,
	and seeks to ensure that surgeons treat a sufficient number of patients with a sufficient variety of problems to ensure that they have the best possible skills.
	The review also recommends the development of congenital heart networks, so that care is better co-ordinated at all stages of a child’s life, and that assessments and ongoing care can be provided closer to where patients live. However, as several hon. Members have said, the review cannot look at children’s heart surgery services in isolation; it must also fully consider the knock-on effect on other specialties at the hospitals in question.
	As my hon. Friend the Member for Leicester South (Jon Ashworth) and the hon. Member for Loughborough (Nicky Morgan) rightly said, the work of Glenfield children’s heart surgery centre is closely linked with its extra corporeal membrane oxygenation service. ECMO helps patients with reduced heart or lung functions to have complex surgery that they might not otherwise survive. Glenfield is the country’s leading specialist ECMO centre, and trains and supports other services nationally and internationally. There is real concern at the possibility that that service will be moved to anther hospital, because of the time that it would take to build up expertise elsewhere. Not only does it take up to 18 months to train new specialist nurses, but it takes many years to develop equivalent experience.
	Ensuring high quality care is not just about surgery standards or links with other specialisms. The wider help and support that families get from doctors and nurses are vital. I was genuinely moved when hon. Members spoke of their conversations with parents and staff in their centres. Time and again, parents emphasise the communication skills of staff, and their ability to explain diagnoses and procedures simply and clearly, at what is often a frightening and worrying time.
	Parents at Glenfield tell me that staff are like members of their families—they can ring day or night if they have any concerns. Such familiarity and trust is crucial, and it links to the issue of providing ongoing help and support, which many hon. Members mentioned. When children who have had heart surgery grow up, they have to deal with difficult issues such as whether they can have children. Many families are understandably concerned about having to build new relationships with a different team of doctors and nurses if their local centre closes. It is vital that the review look closely at the links between child and adult congenital heart services, but it has probably paid insufficient attention to that so far. I hope and believe that that will change before the review concludes.
	As well as stressing the importance of the quality of clinical care, many hon. Members stressed the importance of ensuring fair access to services. We heard passionate speeches about that from my hon. Friends the Members for Leeds East (Mr Mudie) and for Scunthorpe (Nic Dakin). Accessibility matters, because time is of the essence when seriously ill children need to get to heart surgery centres in life-or-death situations, as the hon. Members for Meon Valley (George Hollingbery) and for Isle of Wight (Mr Turner) rightly said.
	However, travel times also matter to families who need ongoing care and support. My hon. Friend the Member for North West Durham rightly said that many parents would travel to the ends of the earth for their children, but as the hon. Members for Leeds North West (Greg Mulholland) and for Oxford West
	and Abingdon (Nicola Blackwood) said, making families travel further than they already travel would make such a difficult time even harder for them, especially if they must also hold down a job or care for other children.
	The difficult balance between specialising services in some areas but ensuring fair access is the crucial issue for the review.

Mark Pritchard: Forgive me, but I am not giving way. I know that the hon. Lady has a long track record on this issue, but I am pressed for time.
	If Mr Speaker had selected the amendment this morning, which is relevant to this point, it would have kicked this motion into the long grass and there would have been no ban on the use of wild animals because we would have had to wait, as a country, for other legal cases to be dealt with in other parts of Europe. That, in itself, is a red herring.
	In his statement to the House last month, the Minister told Parliament, at column 497, that a court case “against the Austrian Government” would “commence shortly”, given that the Austrian Government wanted to introduce a ban. I understand that the papers have now finally been submitted to the court in Vienna, but there is no live case. Interestingly, despite outright bans in other EU countries—I have already listed some and I could add Greece and Luxembourg—a legal case has never been brought or won before. It is not uncommon to hear of Governments sheltering behind courts in Brussels or Strasbourg, but to hear from Ministers in my own Front-Bench team say that this Government are now sheltering behind a domestic court in Vienna is a completely new innovation.
	There are two further flaws in the Government’s so-called legal defence. Are the Government of this country suggesting that the threat of legal action or the possible outcome of court cases is enough to paralyse Government decision making? Fear is not usually a prerequisite to success. What is more, the Government are seeking to put Vienna before the courts in London. If the Government waited for the court case in Vienna— the papers have been submitted, as I said—the case went through and the European Circus Association lost, there would be an automatic appeal to the European Court. That would add more delay and procrastination, further getting the Government off the hook when it comes to introducing a ban in this country. Even if that case were spent, there could be another European court considering another case in another European capital.
	Notwithstanding my comments, the reality is that the Government’s Austrian defence is a red herring, given that the European Commission has clearly stated that a ban is a matter for member states alone. It is an issue that English courts decide. Surely that is something to celebrate in this age of judicial creep from Europe, and also something to exercise and implement. A ban can be introduced in an English court— without waiting for other European capitals to decide and without interference from Europe, which makes a refreshing change.
	The Government have invoked the Human Rights Act 1998—yes, that old chestnut. The sooner the Government scrap the Act and introduce a British Bill
	of Rights, the better for everyone. Let us test the Act in an English domestic court, where even Brussels wants such cases heard. Let the Government have the courage of their own convictions. Legal advice from the Department for Environment, Food and Rural Affairs itself suggests that a ban might breach circus owners’ property rights under the Human Rights Act, so let us test it in the courts. Let us see what the courts have to say—the courts in London and England, not in Vienna, Brussels, Strasbourg, Copenhagen or some other European capital.
	I pay tribute to the Minister of State, who has been put in a very difficult position. On 19 May, he courageously and bravely told this House that he personally would like to see a ban on the use of wild animals in circuses. We also know that officials at the Department for Environment, Food and Rural Affairs want a ban on the use of wild animals in circuses, and it is reported that the Secretary of State herself is minded to favour a ban, yet No. 10 has overruled: so much for devolving power and allowing Departments to get on with their own business, and so much for ending the control-freakery of No. 10; it appears that that tendency under the last Government is continuing under this one.
	The Government have also invoked the European services directive, saying that a ban would breach it and would fail to meet the proportionality legal test. I can tell the House that that is not the case, and that the European Commission has denied that it is the case.
	I appeal to the House to support my motion. Let us get Britain back to where it was in the last century—leading, rather than lagging behind, the world on animal welfare issues—and let us put an end to the use of wild animals in circuses.

Jim Fitzpatrick: I regret that we as a Labour Government did not introduce a ban, but the Animal Welfare Act was a major piece of legislation and we tried our best. Given the constraints and the time frame between when I was appointed Minister of State and the May 2010
	election, there was not long enough to introduce that ban. However we gave a commitment to the animal welfare lobby, to parliamentary colleagues and to the public that we were minded to introduce a ban if we were re-elected, which sadly we were not. I am convinced that we would have gone ahead with that.
	The biggest obstacle to progress that I can remember, as has been mentioned by the hon. Member for The Wrekin, was at the Department for Culture, Media and Sport, which contended that any such ban could harm our creative industries by outlawing the use of animals in film and TV productions at worst or by reducing the number of performing animals available at best. Either way, the contention was that the threat to film and TV production would move it abroad and cost us jobs and revenue. We had numerous discussions about this and we were eventually able to reassure DCMS that that would not be the case and that we could limit the ban to the use of wild animals in circuses, as the hon. Gentleman has outlined. DCMS dropped its objection and the Government had a united policy, which appeared in our manifesto in May last year.
	All kinds of questions were raised about whether wild animals should perform at all and which should be allowed to. My main concern was and is about the conditions in which animals are kept in venues and on the road. We are mostly reassured that modern zoos create environments that try to reflect animals’ origins, natural habitat and behaviour patterns, and we have to ask how that can be done in the back of a cage attached to a lorry driving along the motorways of Britain? Even this morning on BBC “Breakfast”, the camera crew visiting a circus was not allowed to film the animals’ living quarters. I think that that speaks volumes. Why the reluctance? I think we all know.
	The Government say they want to introduce a licensing system rather than a ban. The system would mean that any circuses wishing to have wild animals such as tigers, lions and elephants performing in them would need to demonstrate that they met high animal welfare standards for each animal before they could be granted a licence to keep them. Areas being considered as part of the licensing conditions include the rules on transporting animals, the type of quarters they could be kept in, including winter quarters, and their treatment by trainers and keepers.
	I know from my time at DEFRA that it wants to improve the welfare of animals across the piece and to improve the situation. It has even been suggested by some that the licensing regime could introduce a ban by the back door, but we do not want a ban by the back door—we want a ban through the front door. We want honesty and transparency in the laws and regulations we debate and introduce. We want clarity, not confusion. The public have used their voice to articulate that they want a ban and Members of every party have said that they want a ban. I hope and appeal to hon. Members in all parts of the House when it comes to the vote at 6 o’clock tonight to support the motion in the names of the hon. Members for The Wrekin, for Colchester and myself.

Caroline Lucas: The hon. Gentleman says that he wants science. What about the science from the British Veterinary Association, which says:
	“the welfare needs of non-domesticated, wild animals cannot be met within the environment of a travelling circus… A licensing scheme will not address these issues”?
	The BVA is one of the most respected scientific organisations for animal welfare in this country. What does he say to that?

Matthew Offord: I am happy to stand corrected by the Minister. That allows me to move my argument on.
	Another argument is that a ban on animals in circuses would interfere with a person’s right to the peaceful enjoyment of their possessions because it would amount to a control on how those possessions may be used, but such an interference with that right would not violate the right if it were done in the public interest. I therefore urge the Minister to consider a ban in that public interest.
	The European Courts have decided that, whether or not the control on possessions imposed by a ban is in the public interest, they will have regard to whether a ban represents a fair balance between the needs of the public interest and the rights of the individual. In other words, I tell the Minister that the European Courts will consider whether a total ban is a proportionate measure to achieve the public interest aim in question.
	Accordingly, it is important to consider why exactly a ban is required in the public interest. If a total ban is proposed to ensure that animals are kept in appropriate conditions and cared for by appropriately qualified persons, there is an argument that, unlike the proposed licensing and inspection regime, a ban is not proportionate to the public interest aim being pursued. If a total ban is proposed because it is considered cruel or ethically wrong to make wild animals perform in circuses in the UK, however, a total ban is the only measure that will achieve that public aim.
	Accordingly, if Parliament determines that wild animals performing in circuses are no longer acceptable to the public, it will therefore be in the public interest to have a
	ban on the use of such animals. The European Courts would be very unlikely to question the judgment of this House as to what is in the public interest of the United Kingdom.

Matthew Offord: I suggest, as others have already urged, that we take a lead on the matter. As I have said, I have had some experience with the Human Rights Act this week, but when people use it they find that many in officialdom bow down and decide that, suddenly, it is a very important issue and that those people will get away with what they are trying to achieve.
	In summary, case law from the European Court of Human Rights indicates that a ban would be within the “margin of appreciation” afforded to the United Kingdom. If a ban is proposed because it is considered cruel or ethically wrong in itself to make wild animals perform in circuses in the United Kingdom, as opposed to a ban being proposed because welfare standards cannot be guaranteed, then a ban is the only measure that will achieve that public interest aim and is therefore automatically proportionate.
	Accordingly, a ban will not breach the European convention on human rights, and as a ban is only a control on the use of wild animals in circuses and therefore does not deprive the owner of the animal itself or of their ability to use it for commercial purposes. There is a strong presumption against compensation being awarded to persons who suffer any loss as a result of the ban. If the Government decide to implement a ban, it will not be as revolutionary as we have heard, given the 200 local authorities and the other countries that have been mentioned.
	I do not believe that animals should be subjected to the conditions of circus life. Regular transport, cramped and bare temporary housing, forced training and performance, loud noises and crowds of people are all typical and often unavoidable realities for such animals. Therefore, unless the Government give us a time frame for a ban on animals in circuses, I will vote for the motion.

Nia Griffith: We have already heard many comments from many colleagues, so I will not repeat what has been said. I rise in support of the motion, which
	“directs the Government to use its powers under section 12 of the Animal Welfare Act 2006 to introduce a regulation banning the use of all wild animals in circuses”.
	I had the privilege of serving on the Animal Welfare Bill Committee back in 2006. The Bill became an excellent Act with many good measures asking people to think carefully. It was good in terms of introducing codes and saying that animal welfare really matters. During that Committee’s proceedings, however, I raised the issue of banning the use of wild animals in circuses, and I would have liked to have seen a much slicker process in the Bill to progress the matter at that time.
	Matters have progressed, however. The consultation that the Labour Government instigated in 2009 showed that public opinion is even more clearly behind a ban on the use of wild animals in circuses than it was back in 2006, with 94.5% of people saying that they would support it. It is therefore a great shame that we did not have the time to introduce that ban before the election, after which the coalition Government chose to disregard public opinion by not proceeding with introducing it.
	It is extraordinary that the smokescreen of the European Union has been put up as an excuse for not introducing the ban, because as was explained earlier, the Commissioner has clarified the position and there is absolutely no obstacle whatsoever in the way of doing so. The European Union does not prevent us from doing this.

Caroline Lucas: The right hon. Gentleman is absolutely right. It is the responsibility of member states to act, and it is within our remit and right for us to do so. That is what the EU is saying, so it is incredibly perverse to try to do otherwise.
	In conclusion, the Government’s judgement on this matter is woefully lacking. They have got it wrong on this one.

Zac Goldsmith: I pay my respects to my hon. Friend the Member for The Wrekin (Mark Pritchard), whom I cannot see in the Chamber, and congratulate him on securing this important debate.
	I should like to put it on the record that I am grateful that we will now have a free vote. Applying a three-line Whip to an issue such as this would have made a mockery of the relationship between Parliament and the Government. That is a welcome move in the past couple of hours.
	I shall not pretend that this is the biggest animal welfare issue, because it clearly is not. There are 30 or 40 wild animals in circuses in this country. That does not compare to the millions of animals that have to experience daily the brutality and horrors of factory farming. This is none the less an important issue. There is no justifiable reason for keeping animals such as elephants, tigers, lions and so on in small, travelling cages, away from any semblance of what for them would be a normal life. That is just not civilised.
	My understanding is that until recently the Government took the same view, but that that changed somewhere along the line. It is hard for me—and, I believe, many others—to understand why that happened. For one thing, the vast majority of people support a ban. All the polls suggest that. The public appetite for such entertainment is, at best, fading. It is certainly not a growth sector.

Zac Goldsmith: I began my speech by welcoming the change of heart over the past couple of hours. I have not been part of that process, so I cannot answer the hon. Gentleman’s question, but I very pleased that we
	will have a free vote—it is the kind of issue that should have a free vote. I am very much on the record before the debate as saying that I would have defied a three-line Whip and voted for the motion, as a very large number of Government Members would have done. That is perhaps one of the reasons why we will now have a free vote.
	The most disturbing aspect of the Government’s change of position is that it is not based on a change of heart. As a number of hon. Members have pointed out, the only reason we have been given is that the Government fear a possible EU legal challenge some time in future. The Minister was quoted in The Independent today, I believe, as saying that
	“a total ban on wild animals in circuses might well be seen as disproportionate action under the European Union services directive and under our own Human Rights Act”.
	If that is true, it is hard to imagine anything more embarrassing for the House. The Government are effectively saying that even though they want to do this minor thing, and even though the public would support such a move, they cannot do it because they no longer have the authority. What does that say about Parliament, democracy or this country?
	Let me put it another way. What is the point of making promises up and down the country in the run-up to an election on the campaign trail if we no longer have the authority to fulfil even the most basic promise? That makes a mockery of parliamentary democracy in this country.

Neil Parish: Yes, but putting the ban in place will take a little while, so meanwhile we should consider certain animal welfare issues. The conditions endured by circus animals when being transported are totally wrong. The conditions need to be greatly improved. There must be much more comprehensive inspection of that, which would lead to much greater costs on such circuses. Therefore, a great deal of pressure can be applied in the meantime, before we introduce a ban.
	I may disagree with the points made by the hon. Member for Romford (Andrew Rosindell), but in a democracy he has the right to raise them. He talked about the fact that many of these animals have performed for many years. They will need to be rehabilitated and found homes, so let us use the time available to good effect in that regard.
	We want the Government to listen to the arguments on a total ban. I do not know what the Minister is going to say, but I would like him to say that the Government have thought again and that they are minded to introduce
	a ban in the future. That is what we want. In this day and age, we cannot have wild animals in circuses. Many of us also know about the pain that can be caused by the amount of training those animals are put through and the way in which they are trained to perform in unnatural ways.

James Paice: No doubt we could lay every lawyer in the House end to end and not reach a definite conclusion. I note my hon. and learned Friend’s comments, and obviously I respect them.
	May I turn to the nub of the issue? When hon. Members decide in a few minutes’ time how to react to the motion before us, I hope that they will pay heed to what I have said about the risks attached to it. It is of course a matter for the House to decide, but I hope that hon. Members will not focus on whether we ban or, indeed, wish to end cruelty, because I hope that there is no doubt about our desire on the latter point, but focus on how we go about achieving that end to cruelty in circuses, on which we are I believe united.
	Although a complete ban as advocated in the motion might well achieve that end in time, there are, as I have tried to describe, significant risks in taking it forward with the deadline and using the legal mechanism to which my hon. Friend the Member for The Wrekin has referred. That is why the Government have come forward with a proposal that might achieve the same end with more certainty. Nevertheless, as I say, the House has a right to decide otherwise.
	I understand and fully respect the very high emotions involved, including on the issue of the ethics of animals performing for human entertainment.

Paul Beresford: I thank the Minister for being present to respond to the debate. I understand that he is in some matrimonial difficulty because I have delayed him here this evening and it is his wife’s birthday. If it is any compensation, I am sure that I can arrange for his wife to be given a free bleaching treatment quite soon—on the understanding that he explains to her that it is free, so that he does not get away with allowing her to think that she has been presented with an expensive gift.
	Let me first declare a simple interest and then add to it, because of the specifics of the debate. I am a qualified and practising—although admittedly very part-time—dentist. I am also a member of the British Dental Association, the British Academy of Cosmetic Dentistry, the British Endodontic Society, and the British Dental Bleaching Society. That explains why I am a target for some 36,000 dental practices which are leaning on this issue. I hope that the Minister will bear with me.
	The Minister will be aware that tooth bleaching by dentists has been around for a long time. I first used it about 30 years ago. My tutor was my now retired dental partner, who qualified during the second world war, and his tutor was his father, who qualified shortly after the first world war. Dental bleaching has therefore been used for more than 100 years. In the early days we used a 30% solution of hydrogen peroxide, known in those days as Superoxol. It was extremely destructive of soft tissues, which needed to be protected. In those days we used something called a rubber dam, which was a small sheet of latex rubber with holes placed in it so that the teeth could poke through. The teeth could then be bleached, and the soft tissues were looked after.
	The aim of bleaching is to remove discolourations from the teeth without harming the teeth themselves. The discolourations can come from a number of sources, including tobacco, hard water, tea, coffee and, according to the actresses, red wine. Teeth may also be iatrogenically discoloured, the most famous example being tetracycline discolouration. In the early days of antibiotics, children were given an antibiotic called tetracycline, which was one of the early broad-spectrum bacteriostatic antibiotics and was widely used. Although it generally dealt with the targeted infection, if taken by children it discoloured the developing teeth, sometimes to a grotesque degree.
	Second or adult teeth that have received a blow can often darken quite quickly, particularly if the individual is young. The teeth most frequently hurt in that way are the upper incisors, particularly the upper central incisors. Endodontically treated teeth often darken, particularly if the operator has been unable to remove, or has not removed, all the pulpal tissue from the internal dentine.
	Nowadays, dental restorations are generally of a more cosmetically acceptable material. If someone is to have a filling, it is good for it to be done in a cosmetically acceptable way. It is becoming increasingly accepted as standard practice that when composites, porcelain crowns, porcelain veneers and porcelain inlays are used for restorations, it is sensible to bleach the teeth first. That achieves a benchmark colour to which the new restoration
	is then colour-matched. As the patient’s teeth become discoloured over subsequent years from all the hazards, including red wine, it is possible to use that same process to bring the teeth back to that original benchmark level.
	Dental bleaching is not available on the national heath, but I believe that in some cases it should be, because it is less destructive than other options. To provide a simple example, if an NHS patient has badly tetracycline-stained teeth, the only option on the NHS to restore normal appearance is extensive crowns or veneers. They are destructive to the teeth and much more costly, and in time they will need regular replacement. The better approach is dental bleaching, which leaves the teeth intact and can produce an acceptable colour.
	Techniques of dental bleaching have improved. First, the dentist has to check that the patient’s teeth are in good order; then there are essentially two different bleaching techniques available. The first is the so-called home technique, whereby after inspecting the patient, the dentist constructs close-fitting trays that the patient wears for a period of time at home. The bleach trays are designed to hold the gel against the teeth but away from the soft tissues.
	The second method is so-called power bleaching, which is done in the surgery and generally uses much stronger hydrogen peroxide concentrations. The soft tissues are protected by either the aforementioned rubber dam or, more generally nowadays, by a foam that is set by an ultraviolet light. Some techniques use a light or heat source, although I personally believe that that is more for the image of the procedure as the patient sees it than to benefit the process.
	Nowadays, hydrogen peroxide is generally delivered in varying strengths of carbamide peroxide. Those strengths vary from 10% to 38% when used in the surgery. The actual hydrogen peroxide concentration delivered is lower. For example, 10% carbamide peroxide delivers approximately a 6% concentration of hydrogen peroxide. As logic will tell the Minister, the higher the concentration, the faster the bleaching, but the more likely it is to produce sensitive teeth.
	I hope that the Minister understands from what I have said that the procedure should be in the hands of a trained dental professional, as misuse can cause harm, sometimes extensive harm. Even bleaching at home must be under the direction of a dental care professional. Recent decisions of the General Dental Council have stated that dental bleaching by trained dental professionals is a part of professional dental treatment. That has been endorsed by the Secretary of State for Health and the Health Ministers of Scotland, Wales and Northern Ireland.
	The reason for this preamble is to explain to the Minister that the dangers of the material involved when it is misused must be understood and taken into consideration. Organisations such as the British Dental Bleaching Society run certification training courses to ensure that the dental professional teams undertaking the treatment are properly trained. Unfortunately, a number of non-dental professionals, particularly in beauty salons, are illegally bleaching teeth. Sadly, some of those individuals are using a material called chlorine dioxide, which, although it produces an initial appearance of whitening teeth, actually badly damages them.
	As the Minister will be aware, the fly in the ointment is the European cosmetics directive, which restricts the sale of tooth-bleaching materials containing more than 0.1% hydrogen peroxide. Clearly that makes eminent sense when applied to over-the-counter medicines, but from a dental treatment point of view 0.1% hydrogen peroxide is absolutely useless.
	The enforcement of the cosmetics directive is in the hands of local government trading standards officers on behalf of the Department for Business, Innovation and Skills. Most trading standards officers recognise that higher concentrations of hydrogen peroxide delivered as part of dental treatment by dental professions are completely different from over-the-counter sales or the actions of non-dental professionals. The directive is inappropriate, because tooth bleaching is accepted as part of dentistry.
	In 2005, the European Commission scientific committee on consumer products recommended that tooth-whitening products containing 0.1% to 6% hydrogen peroxide are not safe to be sold over the counter. The recommendation was that they should not be used freely, but that they are safe to be used after the approval, and under the supervision, of a dentist. Since then, the UK Government, along with most EU members, have been trying to change the directive in the light of the recommendation. However, because two or three EU members of the committee keep baulking, there has been no change, despite seven years of pressure. I understand that the Minister could reassure me tonight that the issue is to be taken above the committee, where it is expected to be passed—at last—by a majority vote.
	However, the situation has come to a head locally, as the Minister is aware. A patient of a Hull dentist complained to Hull trading standards. Hull trading standards took samples from the dentist and asked Essex county council trading standards to investigate a firm called Dental Directory, which is a major supplier to dentists and the supplier to the Hull dentist in question. I believe that Essex trading standards officers have taken the names of other suppliers and suggested to respective trading standards organisations that they should investigate. Some did so, but others thought it through and decided that that was inappropriate.
	After full consideration, Essex trading standards sent an e-mail to Dental Directory, which states:
	“This Service has no issue with peroxide-based whiteners over 0.1% supplied to GDC registered dentists for use in the course of a professional whitening service conducted by a registrant. It is the view of this Service that such treatments would be regulated by the GDC.”
	That is a brilliantly sensible response.
	However, another big firm of suppliers, Henry Schein, has a number of different depots in different areas, which are covered by different trading standards. It has received differing instructions. Kent trading standards echoed Essex’s eminently sensible position, but Medway trading standards informed Henry Schein that it is not allowed to supply dental bleach with over 0.1% hydrogen peroxide. Needless to say, enormous pressure was applied. I suspect to the Minister’s relief, Medway has reverted to the sensible Essex county council position.
	That leaves me with two simple requests for action to sort out this particular nonsense. First, I urge the Minister, if at all possible, to obtain a change in the directive, and
	secondly, to inform all UK trading standards that the approach taken by Essex and Kent trading standards should be the norm.
	As the Minister may recall, a few moments ago I mentioned beauticians and non-registrants illegally bleaching teeth. Many of those people are dangerous. For example, a plasterer from Kent plasters walls during the day, and bleaches teeth in people’s homes in the evening, using 38% hydrogen peroxide, with no guards or safety measures. To put it bluntly, he probably burns the gum off the bone and the teeth. He is dangerous.
	Others use chlorine dioxide. As the Minister’s school chemistry will tell him, when chlorine dioxide hits water, as in saliva, it turns to hydrochloric acid, and eats the enamel surface off the teeth. The initial slight whitening appearance turns, on further applications, yellow and then brown, as the dentine shows through because the enamel disappears. To put it bluntly, that simply wrecks teeth.
	To add to those problems, a number of highly acidic tooth-whitening products are available over the counter for personal, home bleaching. Many are highly acidic. All of the highly acidic ones are highly damaging. To my amazement, even two reputable UK pharmacies—I am not naming them for the moment—are selling such products over the counter. I am therefore also asking the Minister to assist, through trading standards, in stopping beauticians and other non-dental registrants bleaching teeth. The General Dental Council is taking action, but it does not have the strength and spread of trading standards.
	In addition, will the Minister seek a ban on the use of chlorine dioxide for teeth bleaching, including on the supply of acidic, over-the-counter home bleaching materials? An awful lot of smiles on the faces of some very pretty young ladies are being wrecked in the United Kingdom.

Edward Davey: I congratulate my hon. Friend the Member for Mole Valley (Sir Paul Beresford) on securing this important debate. It is not the first time he has come to the House to campaign on this issue—he deserves a lot of credit for his persistence and determination. This is a serious issue for those adversely affected by people using certain materials they should not, as he explained. I also thank him for the offer to my wife—I will convey it to her later this evening.
	This is a complex matter involving overlapping issues, which my hon. Friend highlighted. Particular factors to consider are: first, that the current European-derived law clearly restricts the level of hydrogen peroxide to a level at which it cannot bleach teeth. Secondly, prevailing scientific opinion on the safety of hydrogen peroxide in teeth-whitening products is out of step with current maximum limits. Thirdly, how do we most appropriately enforce the law? Fourthly, who should be undertaking teeth whitening? Should the role be reserved to dentists or should it be available from other suppliers and even for home use? Finally, there is the issue about the safe use of other substances used as an alternative to hydrogen peroxide.
	Although I recognise how deeply frustrating this matter is for all involved, I will try to address these points and highlight a possible resolution of the issue.
	I hope that I can give my hon. Friend some satisfaction tonight, but if there are other points he wishes to make that he feels have not been covered, I will be happy to correspond with him, and if necessary meet him. There is no doubt that teeth-whitening products are cosmetic products within the meaning of the cosmetic products directive. Hon. Members will know that the UK has been pressing for a number of years on the cosmetics regulatory committee for the maximum limit for hydrogen peroxide to be increased in line with the opinion of the scientific committee on consumer products in 2005, to which my hon. Friend referred.
	The scientific committee’s view was that allowing a greater percentage of hydrogen peroxide in teeth-whitening products would not be detrimental to the health of consumers. Since then, however, there have been protracted discussions in Brussels on matters of detail. We are now in the position where the European Commission has proposed a number of directives to amend the cosmetic products directive, each of which has failed. The latest was submitted to the standing committee on cosmetic products for vote by written procedure in May last year, at which time five member states voted against the proposal.
	The Commission was therefore required to reconsider its proposal, and has since amended the directive. Instead of putting it back through the regulatory standing committee, the Commission intends to submit it to the Council for a council directive. Let me explain the detail of this new development. The Commission believes that use of teeth-whitening products containing more than 0.1% and up to 6% hydrogen peroxide can be considered safe if the following conditions are satisfied: first, if an appropriate clinical examination takes place to ensure the absence of risk factors; and, secondly, if exposure to the products is controlled to ensure that they are used as intended. Teeth-whitening products should therefore not be directly available to the consumer. For each cycle of use, the first use should be limited to dental practitioners or under their direct supervision. This will be communicated to the Council before the summer break, and we will support it.
	I note that the General Dental Council considers tooth whitening the practise of dentistry, which is limited to GDC registrants, and this ties in with the new proposal for a directive. Indeed, earlier this year the GDC successfully prosecuted a non-registrant under the Dentists Act 1984. I would urge members of the public who have received a treatment about which they have concerns to raise it with the GDC. This also applies where alternative teeth-whitening treatments, such as chlorine dioxide, are used
	with unsatisfactory or damaging results. My officials will contact the Commission about the concerns of the British Dental Association over the use of chlorine dioxide in teeth-whitening products.
	On the question of enforcement, I understand that there have been concerns about investigations carried out by trading standards services into the supply of teeth-whitening products, some of which contained significant levels of hydrogen peroxide—more than the newly proposed amendment would permit. Trading standards services have a duty to enforce the Cosmetic Products (Safety) Regulations 2008, but they take a risk-based approach to enforcement. To our knowledge, they have never actively targeted dentists, but where suppliers are marketing home-use kits, they have a responsibility to investigate where such products could reasonably present a risk to the consumer.
	My Department neither controls nor directs trading standards services in their enforcement activities. However, officials will be making them aware of the latest developments in Brussels on the issue, so that they can understand the direction in which the law is likely to develop. Officials have also been in contact with many of the trading standards departments looking into the matter to ensure that a consistent approach will be taken. Decisions on whether to progress investigations into suppliers of home-use kits will remain decisions for local authorities. It is unfortunately true, however, that many suppliers of teeth-whitening products have already anticipated a change in the law, which has made the task of trading standards officers extremely difficult over the past few years. On a separate but closely related note, I am pleased to say that a new and specific element on enforcement will shortly be added to the red tape challenge. We would encourage businesses to go on the red tape challenge website and tell us about the problems they are having with the implementation of regulations.
	In conclusion, I hope that I have been able to shed light on the latest developments, which could offer a way forward on this protracted issue. Subject to agreement in Brussels, the new directive will clarify the law. I also believe that the decision of the General Dental Council will help to clarify the position on the provision of teeth-whitening services. I am grateful to my hon. Friend for enabling me to put that on the record, and I hope that he and the dentists on whose behalf he has so persistently advocated will be pleased with it.
	Question put and agreed to.
	House adjourned.